What is a Herniated Disc?
A herniated disc, sometimes called a slipped disc, happens when the soft tissue which cushions bones in the spine bulges out. This can happen in any part of the spine but is most common in the lower back or neck.
This condition is most prevalent in people aged between 30 and 50 years and is twice as common in men than women. (1)
A herniated disc is most often caused by natural degeneration which happens with aging. It can, however, be the result of an accident or injury. (2)
The spine has many bones, called vertebrae. Between them are discs which are soft tissue. Each disc is made up of a casing which is elastic (cartilage) and filled with a substance resembling jelly (nucleus pulposus).
The discs cushion the vertebrae and help to keep them in place.
Discs degenerate with age and can lose their ability to cushion the spine. This might cause a disc to bulge out from between the vertebrae. Injury could also cause a disc to bulge or become herniated.
The disc is then able to press on nerves in the spine and irritate them.
Not everyone with a slipped disc will experience symptoms. In fact, as many as 50 percent of people with a herniated disc don’t know they have it. (3)
When symptoms are present they often occur as a result of the disc putting pressure on the sciatic nerve (sciatica). The symptoms include:
The pain associated with a herniated disc in the lower back can be sudden and sharp. Alternately, it can begin slowly, presenting with a dull ache. This pain often travels from the lower back, then through the buttocks and eventually down the legs.
The pain might be made worse by coughing, sneezing and moving around. Often it will be more severe in the legs and buttocks than it is in the lower back. (4)
A herniated disc in the neck can also cause pain in the shoulders. This pain might be described as burning. (5)
Pressure placed on the sciatic nerve by a herniated disc can cause feelings of numbness in the legs, feet or buttocks.
This numbness can be partial or total and sometimes causes paralysis in a leg or foot. If paralysis happens, it’s a sign the condition is serious and the nerves in the spine are potentially damaged. (6)
A herniated disc in the neck can result in numbness in the arm or hand. (7)
A tingling or burning sensation might be felt in the legs or in the arm, depending on the location of the herniation. This might be described as pins and needles. (8, 9)
When a herniated disc presses on the sciatic nerve, cramps can be felt in the legs or buttocks. These can range from excruciating to mild and may last for several weeks. (10)
A feeling of weakness in a leg or arm might also be felt when a disc is herniated. (11, 12)
Bowel and Bladder Function
Function of the bowels or bladder can sometimes be affected. If this happens, immediate medical attention is necessary. It could be symptom of a medical emergency as a result of the spinal nerve roots being compressed, called cauda equina syndrome. (13)
There are no stages associated with a herniated disc. There are, however, three different categories, based on severity.
A prolapse describes an instance when a disc in the spine moves or slips from its normal position. (14)
The disc bulges out from the space between the vertebrae. When prolapsed, the outer layer of the disc is not broken. (15)
This occurs when the outer layer of the disc tears, allowing the tissue held inside to spill out. This tissue is still connected to the disc. (16)
This type of herniated disc happens when tissue from an extruded disc detaches and enters the spinal canal. (17)
There are also factors which can predispose a person to the likelihood of experiencing a herniated disc. These include:
Personal Risk Factors
Discs degenerate as we get older and as a consequence are more likely to become damaged. Ages most at risk are between 45 and 64 years.
Discs also lose elasticity due to normal wear and tear as we get older. Fluid can then leak from them. As a result, they become dry and brittle and are no longer able to cushion the vertebrae effectively.
Being very tall or overweight can predispose someone to a herniated disc.
Other factors which might contribute include: being inactive, smoking and suffering mental stress. Exercising too hard can also cause a herniated disc. (18, 19)
Occupational Risk Factors
Strenuous activity, such as lifting heavy objects, twisting or bending, can exacerbate the chances of a herniated disc. Jobs involving operating or driving machinery which vibrates might also contribute to this condition. (20)
A herniated disc will often get better on its own within about six weeks.
The pain might initially be quite intense and it is natural to feel the need to rest. However, it is beneficial to get moving again as soon as possible. Once a person feels able, exercise will speed recovery. This could include some gentle walking or stretching, increasing activity levels at a pace which your body dictates.
Over the counter painkillers, including ibuprofen and paracetamol, may relieve pain. Taking these medications on a regular basis as directed, and not just when pain is felt, can help keep people mobile.
A pharmacist will be able to advise which painkillers are suitable and how many a person should take. (21)
When pain does not ease through self-treatment, or if it gets worse, you should visit a doctor.
Different treatments can be considered, depending on the severity and duration of the symptoms.
A doctor might prescribe medications which help to reduce inflammation and relieve pain. These include non-steroidal anti inflammatories (NSAIDs), codeine, tramadol or morphine.
They could also prescribe muscle relaxants or administer steroid injections. (22, 23)
This therapy helps by teaching stretching and exercises which are aimed at restoring movement and building strength. By using massage and manipulation, this treatment can help improve the circulation of blood, relieve stiffness and pain, and help fluid drain from the body. It can also help you to relax.
Acupuncture is another practice used by therapists, to reduce pain and promote recovery.
Other options available include the use of either electric current or sound waves. Electric current is administered using a specialized machine and can help relieve pain.
Sound waves administered using an ultrasound machine help stimulate the circulation. This can reduce pain and muscle spasms, and also promote healing. (24)
When a herniated disc doesn’t respond to non-invasive treatment, a doctor might refer the patient to a neurosurgeon. This could also happen if the pain is worsening.
The types of surgery considered include:
This is one of the more common surgeries when the herniated disc is located in the lower back. The part of the disc which bulges is removed, along with any fragments which could be putting pressure on the nerves in the spine.
Cervical Discectomy and Fusion
This surgery is used when a herniated disc is located in the neck. The whole disc which is bulging is removed and replaced with bone. Spinal support might be provided with the addition of a metal plate. (25)
What is a herniated disc? A herniated disc, sometimes called a slipped disc, happens when the soft tissue which cushions bones in the spine bulges out.
What are the signs of a herniated disc? Pain in the lower back or neck, radiating down a leg or arm, is a sign of this condition. Tingling, burning, numbness and cramps might also be felt.
How do you develop a herniated disc? The symptoms associated with this condition are often caused by a disc which bulges, pressing on a spinal nerve. This could be as a result of aging, injury, obesity, being inactive or stress. It may be the result of an accident or injury. Some occupations can contribute to the onset of this condition.
How are you diagnosed for a herniated disc? A doctor will look at your medical history and carry out a physical examination. They may do a test involving leg raising. This helps identify where a herniated disc is located. They could test your reflexes. If it cannot be ascertained whether a disc is herniated, imaging tests such as CT or MRI scans can be carried out. (26)
What are the best treatments for a herniated disc? Often, this condition will rectify itself over time, painkillers can help relieve the symptoms. Physical therapy can also help people become more mobile. If symptoms persist, surgery might be considered.
What are the long term complications of a herniated disc? In about 90 percent of people, the symptoms of this condition usually subside on their own. The remaining 10 percent might experience recurrence or long term pain. (27)
Is a herniated disc considered a disability? This condition is not considered a disability. However, there are occasions when social security benefits might be paid. (28)
Is there a cure for a herniated disc? This condition can be successfully treated in most cases.
Is a herniated disc life threatening? A herniated disc is not considered life threatening. There are times when it can interfere with the function of the bowel and bladder. In this case it is a medical emergency. (29)
A herniated disc, sometimes called a slipped disc, happens when the soft tissue which cushions bones in the spine bulges out. While sometimes very painful, this condition often rectifies itself over time.
On the occasions when pain cannot be managed by medication or the condition worsens, surgery may be offered.
The good news is that the long term prognosis for the majority of people with a herniated disc is excellent.